Waiting for the “liquid revolution” in the adjuvant treatment of colon cancer patients: a review of ongoing trials

• Published in: Cancer treatment reviews 2024-05, Vol.126, p.102735-102735, Article 102735
• Main Authors: Conca, V., Ciracì, P., Boccaccio, C., Minelli, A., Antoniotti, C., Cremolini, C.
• Format: Article
• Language: English
• Subjects: Adjuvant chemotherapy; Biomarkers, Tumor - genetics; Chemotherapy, Adjuvant - methods; circulating tumor DNA; Circulating Tumor DNA - blood; Clinical Trials as Topic; Colon Cancer; Colonic Neoplasms - drug therapy; Humans; Liquid Biopsy; Minimal Residual Disease; Neoplasm, Residual; Prognosis
• ISSN: 0305-7372; 1532-1967
• DOI: 10.1016/j.ctrv.2024.102735

•Optimising the identification of patients who should receive adjuvant chemotherapy is a major challenge in early colorectal cancer.•The use of liquid biopsy to detect circulating tumor DNA (ctDNA) as a marker of minimal residual disease has been shown with dramatically growing interest in the last years.•Several ongoing trials are using ctDNA analysis to guide adjuvant treatment to de-escalation/escalation strategies in ctDNA-negative/ ctDNA-positive cases.•Some trials are investigating the role of post-adjuvant systemic therapies in ctDNA-positive patients after adjuvant treatment completion.•Due to its ability to early detect disease recurrence, some trials are investigating ctDNA-guided surveillance during follow-up of resected colorectal cancer patients. Since colon cancer has a high rate of shedding of tumour fragments into the blood, several research efforts are now focused on the investigation of the minimal residual disease through the detection of ctDNA to tailor the adjuvant therapy of colon cancer patients and optimize its cost/effectiveness balance. The negative prognostic impact of detectable ctDNA in patients’ blood after radical surgery for colon cancer is well established. Several clinical trials adopting heterogeneous designs and techniques are now ongoing to translate promises into daily practice by answering five general questions: i) is a ctDNA-guided decision making efficacious in the post-operative management of colon cancer patients? ii) are de-escalation strategies possible in ctDNA-negative cases? iii) are escalation strategies useful to improve the prognosis of ctDNA-positive patients? iv) when MRD is identified at the end of the adjuvant chemotherapy, is another post-adjuvant systemic therapy efficacious? v) can we exploit ctDNA technologies in the follow up of colon cancer patients? This review focuses on currently ongoing trials and how their results may affect the ctDNA “liquid revolution” of early colon cancer.